On the spectrum or go gentle vs fight, I'd have to say, now is the time is history where "fight" makes the most sense.

This is not abstract for me. I have not one, but two forms of cancer.

Both were considered incurable when I was diagnosed.

Both have treatments now that, IN SOME PEOPLE, lead to remission.

I still don't know which group I am, but I'd be dead from either one by now, if I hadn't elected to treat.

New treatments, for SOME cancers are literally coming out monthly.

So the fact that you can't be cured today, does mean there won't be a better treatment by next year, if you can hang on.

I should find out soon on my more aggressive one. Either way, I plan on continuing to try.

Last week one of my patients with preterminal NYHA Stage IV cardiac failure looked into euthanasia.

He found predictably that it is now legal in my country but takes months and formidable legal resources to obtain it. Legalisation of euthanasia has, as everyone in the field warned multiple times, made it much harder to obtain and now requires a lot of time, effort and money.

The well meaning, naive proponents of legalisation of euthanasia have actually made things a lot harder for those who want it. The potential legal penalties for not getting the paperwork right, include loss of employment, deregistration and homicide charges. So now virtually no doctor wants to be involved for any amount of money.

So I told him how to contact the local palliative care unit when he decides to die, gave him documentation attesting to his preterminal , incurable status and taught him the magic words to almost instantly access that terminal, euthanising, life ending dose of mist. morphine...

"I have breathlessness and bone pain"

Also told him never again to say the word "euthanasia" to anyone, unless he wants a ride on the endless merry-go-round of legal paperwork.

Placing the hands in the abhaya mudra is optional...

As the article points out, CPR really is oversold. I was a volunteer firefighter and did CPR multiple times, none of those people survived. I watched (and listened) as firefighters did CPR on my wife after she had a massive heart attack, hanging on to some hope but knowing deep down it was futile. But they transported her to emergency anyway.

I watched my father slowly die from sepsis that began with an infection in a toe. Surgery to improve leg circulation failed and his toe was amputated. The antibiotics not only induced the sepsis but led to a C. difficile infection. His mind deteriorated almost overnight. My mom couldn't make the decision to end care and place him in hospice, so the decision was passed to me. He had made his care wishes clear in writing, so while it was a hard decision, I knew it's what he wanted. He died less than a day later.

I'm working on my own care directives so my kids know exactly what to do when it's my time. With luck, they'll be able to ensure those directives are followed.

I'm a physician, an old one. We're lucky to live as long as we do, but life will end. The article emphasizes the value of dying peacefully. Sure, that's how we want it to be, but we have to make it known to assure it goes that way.

Don't know what happens elsewhere, but every time I see a doctor someone asks if I have a signed, notarized directive. Yes, I've done that, but so should everybody else concerned about the issue.

I have asked aged patients the same question. More than not the answer is "no". Why haven't you? Various versions of "on my list of things to do". We can't really predict future events, in our own interests best to be prepared. Some will take the hint, more than not, people procrastinate.

At least I've done what I can do, but we can't save people from themselves. Maybe people in healthcare are more aware of what's at stake, but everyone has the option to make it as clear as possible their wish (no, their demand) to die in peace.

This article is making a LOT of "convenient" assumptions.

For all we know, the more likely scenario is that Charlie, like a sizeable percentage of his doctor peers, was burnt out, tired, and depressed, did not really have an overwhelming (some might say "healthy") desire to survive (in fact, perhaps quite the opposite), and saw the cancer as a non-undignified quick "way out".

Doctors (and medical professionals more generally) rank among the highest in occupational risk of mental health disease, especially for things like addiction, alcoholism, generalised anxiety, ptsd, depression and suicide.

I have no objection regarding the choice he made, but let's not glorify it as the "natural" thing to do either. This narrative is harmful to people who "do" desire to survive but are scared, which may then prevent them from making a dispassionate decision regarding their care.

> Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack... He explained to me that he never, under any circumstances, wanted to be placed on life support machines again.

> Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it.

It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.

> Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a ‘tension pneumothorax’), walked out of the hospital.

This point has been made by many medically trained people over decades. It's a very energetic intensive process, it cracks ribs. If it's not done promptly the brain has been starved of oxygen.

While I understand people not wanting to drag politics into everything I invite you to think about this and the situation of the senior senator for Kentucky.

My mother died last month,I have seen that same costly futile care before when it was performed on my father two decades before, but we had no choice. Both were injected with a dozen drugs syringes and perforated with tubes, hooked up to machines.

Although I am somewhat healthy, yet looking at rocking 60 made me contemplate and feel contentment just upon reading about psilocybin for patients dealing with life-threatening diagnoses, end-of-life anxiety (plus a dozen documentaries and 2 on Netflix). Learning about it has offered me relief and lasting drop in existential distress, especially as it helps melt the ego into everything. https://pmc.ncbi.nlm.nih.gov/articles/PMC9833165/

As a doctor, I think we are prepared for our own death (not so much for illness though). Especially during the last days or months we know exactly what's happening. I agree that the less-care-but-less-side-effects way is chosen much more often by doctors for themselves and their close relatives (I personally administered to my mother opioid to accelerate death due to terminal cancer a couple of days before the expected end that would be tortuous).

For my end stage patients I advise full palliative analgesic and sedative therapy but usually against futile chemos and intubations. There is a discussion where ICU doctors and oncologists have to take part.

Here in the UK there is an ongoing debate happening more or less behind the scenes around the language that should be used for families of patients nearing end of life. The standard question is: Should we "do everything possible" to keep someone alive? The proposed better question is: Should we "allow natural death"? Any doctor understands intimately that these two questions are equivalent. Understandably, the average person doesn't. Why wouldn't you "do everything possible"? In most of these conversations the argument against just doesn't come up.

I really don’t agree here. The focus should be on combating the observational bias that is the cause of these decisions. The doctors remember the “futile” cares for the patients where it had the worst results. We’re wired to concentrate on the negative outcomes, and doctors are bathing in it.

I recently read the book Being Mortal by Atul Gawande, a doctor. He emphasized how terminal care should focus on quality of life instead of attempting to prolong it and making it awful.

I worked for some years in cancer prevention.

Last year, my mom was diagnosed with Stage 4 cancer. My family largely agrees with this article: treatment was a mistake and likely worse than the disease (bar palliative care and a stent).

The headline we used in cancer education is about 38% of cancer cases are likely caused and perhaps preventable by modifiable lifestyle factors: Tabbaco, infections, alcohol, UV.

Widespread vaccination (HPV, Hep B/C etc) and precision prevention (genetic counseling and preventative interventions) add another layer of preventative opportunity, and could significantly move the needle inclusive of and beyond/above lifestyle factors.

This leaves a lot of room for change, but requires a changing of economic incentives and cultural factors: which are incredibly slow moving ships.

The next layer is early detection (pre-cancer and early cancer); and technology advancements look promising - multi-cancer blood tests like Galleri and whole-body MRI (Prenuvo, Neko, Midjourney) are scientifically and economically promising, but all commercially ahead of their time.

These two additional pots potentially provide another significant opportunity to reduce the burden where the cost-benefit on personal suffering makes sense.

I’d add as the last personal suffering cost-benefit promising intervention layer targeted immunotherapy (and perhaps to a lesser extent ADCs/smart-bombs), where many patients enjoy results without bearing equal or exceeding suffering. Though with smart bombs, the maths isn’t as convincing, and with both you’re heading into lower odds bets.

Ofcourse, many people are helped by classical chemo, but much of the time (and especially in later stages) you’re hoping to be the exception, and at this point, the population wide experience is in many cancer types net negative.

Many people pin there hopes on this last, narrow category of intervention for breakthroughs; and hopefully they come; but likely this hope, attention and capital is misplaced.

Previously...

How Doctors die. It’s not like the rest of us (2016) - https://news.ycombinator.com/item?id=28463482 - Sept 2021 (291 comments)

> They want to be sure, when the time comes, that no heroic measures will happen – that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with cardiopulmonary resuscitation (that’s what happens if CPR is done right).

I have been seeing so much anti-LUCAS-machine content on the internet lately; it is far too prevalent to be anything but an astroturfing campaign. From whence this meme?

Can confirm. Top of the article could be about my dad. Same flavor of cancer and everything.

Title should be corrected to the original:

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How doctors die. It’s not like the rest of us, but it should be

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Note to submitters: Check the title after submitting. If the HN algorithm mangled it as badly as this one, edit it!